Category Archives: Clinical Safety

“Wicked” Barriers to Innovation and Adoption

Sometimes we just have to JUST DO IT! In the NHS we have too high a tolerance for inaction and too little tolerance for honourable failure.

I’ve just come back from the Healthcare Innovation Expo in Manchester, where there was much talk about the need to encourage innovation. I’m all for that but I think it’s widely agreed that the problem is not innovation but getting innovation that works widely and rapidly adopted.

I’m trying to help NHS England do some innovative things with Open Source and we made lots of progress over the two days at Expo, but I again encountered examples of two of the wicked barrier to innovation and its’ adoption.

I call these things “wicked” because they are both things that are genuinely important and that we must properly consider, but they also represent two of the most effective spanners that those who feel threatened by the innovations of others can throw in the works to slow down adoption.

They are:

  • Clinical safety
  • Evidence

Don’t get me wrong clinical safety is important and I support the application of standards like ISB0129, which I think is actually well put together and does a good job of encouraging a proportionate approach to clinical safety. What gets my goat though is the way in which clinical safety can be used as excuse for not doing things differently. I wouldn’t mind so much if we knew that current systems and processes were safe, but the fact is that we know they are probably not and I don’t see a good case for slowing down innovation longer than is necessary to be confident that they at least marginally reduce harm. Too often “the Best is the enemy of the Good” and the paradox is that the laudable desire to ensure that responsibility for clinical safety is nailed down and hazards are properly assessed and managed makes it desirable, to some, to stick with current systems and process where the hazards are not well understood or managed, but where nobody’s head is on the block if things go wrong.

Similarly with evidence, we should of course seek evidence to support that what we plan to do will be effective in achieving whatever it is we hope to achieve, but again bleating “where’s the evidence” is a great way to throw a spanner in the work for those who lack a more cogent reason for objecting to a particular course of action. Again, I’m particularly irritated as we sometimes have little evidence that what we currently do works well and more often have evidence that it doesn’t so why not try something different. I’m also concerned when people ask for evidence for things that have not done before. Clearly, if we have not tried something before we can’t have direct evidence of its effect and the more innovative an idea is the more difficult it is to find proxies for direct evidence. Sometimes we just have to rely on professional judgment, faith or plain old gut feel and just do it. We have to take this route if we want innovation and adoption but we also have to recognise that we might be wrong, evaluate what we do and “Fail Fast”. We also have to ensure that we don’t castigate those who try and innovate when they fail, as long as they fail as fast and with as little harm as is reasonable practical; sadly in the NHS we have too high a tolerance for inaction and too little tolerance for honourable failure. Given the challenges we face we know inaction will inevitably lead to catastrophic failure and have encourage people to, at least, do something.

You can read more about barriers to innovation in my blog “What Entrepreneurs Want” over on the HANDI web sitenovation