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