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'Adopting good practice from elsewhere is not innovation'


The Queen’s Nursing Institute’s Rosemary Cook challenges nurses to think about what would really transform care for patients

True innovation is rarer than an adequate budget. The internet was an innovation. Artificial hearts were an innovation. But most of what we call innovation in healthcare is just a tweak of what went before.

And often that is exactly what is needed. You can’t just throw everything up in the air and wait to be excited by where it lands when you are dealing with sick or injured people, a workforce on permanent contracts and a government-directed service.

Unfortunately, this caution has sometimes led to a concrete culture in the NHS where everything stays as it has always been, and people who try to change anything come away bruised and bleeding, having made no discernible impact.

I am not referring to NHS structures or organisations - we all know how often and how radically they change - but to day-to-day matters, and the interactions between professionals and patients, and between professionals and services.

“Communication between primary and acute care should not be an innovation - it should be the norm”

Whole programmes, even entire agencies - including the former Modernisation Agency and the soon-to-be-defunct NHS Institute and National Patient Safety Agency - have been set up to try to embed some change management techniques into the service, or to provide off-the-shelf change programmes to make it even easier.

Many have succeeded. These include the Productive Series, the Plan-Do-Study-Act cycle, cancer networks and assistant practitioner roles. Yet there are still many places where “change”, “new” or “innovation” are resisted, reviled and, if possible, returned unused to sender.

Sometimes, this appears in the most tangible way: in bricks and mortar. Brand-new health centres reproduce all that was worst about old-fashioned surgeries: uncomfortable chairs in rows; reception desks up to chest height; and strict separation of services. Intermediate care units look like a ward from the 1970s, as if people need to practise using bed tables and walking in oversized foam slippers before they go home.

At other times, resistance is to changes in working practices. So, we keep calling patients back to outpatients every six months for a routine check, or expect them to wait in all day for a visit that may or may not happen.

Asking for “innovative projects” or local “improvements to services” in a competition for funding or recognition awards is a salutary exercise. There are sometimes a few really great ideas. More often, there are a whole series of examples of the fact that “innovation” can just mean “new to us” or “not yet done here”.

The Queen’s Nursing Institute and many others like it, such as the Nursing Times Awards, that run innovation projects or awards share an ambition: to reach a point where some things never appear on application forms because they no longer fit this embryonic definition of innovation.

For example, communication between primary and acute care should not be an innovation - it should be the norm. Involving multidisciplinary colleagues in the care of people with complex conditions should not be an innovation. Involving patients in their care shouldn’t be either. Sharing information across teams is not a new idea. Nor is using a structured assessment tool and a best-practice protocol.

It is too late to invent the artificial heart, and most of us are a long way from discovering the successor to the internet. But it would be good to challenge ourselves to take a big step up, from just adopting other people’s normal practice to really asking what would transform things for patients.

Because innovation can mean something progressive, ground-breaking or life changing, and it would be good to have those words associated with nursing.

Rosemary Cook is director of the Queen’s Nursing Institute


Readers' comments (12)

  • what would really transform care for patients?

    How about having a decent and safe number of trained, qualified, well paid and well looked after staff Nurses on the ward?

    How's that for bloody innovation?!!!

    "But it would be good to challenge ourselves to take a big step up" Maybe, but it would be better if we had the top level support and financial backing to implement our ideas.

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  • I have great respect for the QNI but with respect I am not sure that hospital nursing takes any notice of the QNI.

    We really do need nurses to actually use evidence-based practice that is availabe and supported by good research.

    Every NHS organisation's Director of Nursing should have all the decent EBP nursing models at their fingertips and insist that they are used in the workplace, monitor and evaluate their use. I am not sure that this is the case so far.

    Sorry - but there is innovation in nursing - it exists in research and developing models of practice and it is the profession that often choose either not use these or do not know that these exist. Neither do the NMC enforce using EBP despite it being a requirement of the code of conduct.

    Sometimes innovation hits the headlines but it is often about a clinical task rather than a nursing model - which an 'ethos' of assessment, practice and evaluation.

    Nurses are not that good at evaluation - they tend to concentrate on practice.

    I hope this statement above stimulates some debate please!!

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  • Hi Wales Nurse

    You'll find that people only tend to respond to these articles or previous postings if they're moaning about how terrible everything is.

    You've dared to suggest that there is innovation in nursing and, what's more, actually dared to suggest a way to ensure EBP becomes the norm. I doubt you'll get much response due to your bared faced cheek of being optimistic and measured.

    However, for the record, I agree. There is a great deal of innovation in nursing and quite a lot of it takes place in Primary Care

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  • Anonymous | 30-Aug-2011 2:24 pm: "You'll find that people only tend to respond to these articles or previous postings if they're moaning about how terrible everything is. " Utter trite rubbish. There is a lot of debate within these threads, both negative and positive. The negative does often outweigh the positive, because we as a profession have a lot to be angry about, but do not dismiss everyone simply as 'moaners'.

    Wales Nurse, I suppose that depends on the definition of innovation doesn't it? But taking your own example I would certainly agree that there is a lot of innovation in Nursing already on an individual level, you or I or any other individual Nurse for example would research and evaluate EBP and put this into practice individually, the sheer fact that this changes regularly and we need to keep updated is evidence of innovation within practice is it not? But I agree that this needs to be implemented much more uniformly at a cultural/trust level. To much emphasis is put on us as individuals to implement it, and not nearly enough emphasis on the managers/trusts ensuring it is there and visible for all to see and implement I agree.

    However, if we are talking about innovation as change on a cultural level, I tend to agree with Rosemary Cook. The introduction of Nurse led services, the introduction of Nurse specialists, even Staff Nurses attempting to change routine practice on their ward to try and improve care, all often hit an establishment wall (from a variety of sources) that blocks them from progressing as they should or even stops them dead in their tracks. Nurses are not meant to be clinical specialists are they? The Nurse led walk in centres aren't any use because Nurses aren't as good as a GP are they? Nurses aren't good enough to make truly innovative change are they? Perception of our profession often plays a large part in this, but so too does our lack of power and influence at trust/government level. How about the old chestnut of Staff Nurses crying out for a safe Nurse/patient ratio? How often is that blocked? Have you ever had a fantastic idea for creating a service or a department that would benefit patients and the NHS, only to be told there is no money for that? I have!

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  • "There is a lot of debate within these threads, both negative and positive"

    Actually, I respectfully disagree. most of what gets posted on here is very negative. I suggest you re-read your last posting, it started off very well, but then soon then fell straight back into negative comments about managers and etablishments and people trying to "block" things

    I sometimes think it's no wonder nurses have such a reputation for being moaners

    "Trite" was an interesting adjective though

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  • Anonymous | 30-Aug-2011 2:24 pm

    you managed to incorporate moaning AND sarcasm into your post. well done!

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  • Oops there goes another one.....we just don't stick together, and everyone knows it, from goverment to management. The thing that really gets me about our profession is that we progress through the ranks for most jobs, so where is the support, when you have been there, done it? Where does it all go wrong, and we lose the compassion for 'the shop floor'? Have we suddenly become aware that we were doing it all wrong then? If so then those of us 'on the shop floor' need to question ourselves, and stop bickering.

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  • I see everyone has spent their time defending their right to complain bitterly rather than actually responding to Wales Nurse's request to debate innovation.

    Which rather proves my point really

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  • Anonymous | 30-Aug-2011 3:25 pm Well I'll tell you what then, try debating my and others points about innovation instead of simply moaning yourself.

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  • lets stick to the main arguments of the article!

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