It takes a system to spread innovations: On the importance of applying a systems perspective when spreading innovations across complex contexts

Alexandra Ziemann, PhD

EIC Board Member, Senior Research Fellow at Centre for Healthcare Innovation Research, City, University of London, UK

Email: alexandra.ziemann@city.ac.uk, Twitter: @_aziemann

Imagine, you are tasked to spread an innovation for the benefit of the many across a diverse geography, for example, the national roll-out of a digital platform facilitating data sharing about a patient’s medicines between hospitals, community pharmacies and general practitioners – how do you best go about it?

When spreading innovations, the aim is to cover a diverse population, a diverse geography, several organisations, often from different sectors, and these contextual factors will be different for the next new something you want to spread and in the next new region across which the innovation is supposed to spread. We are faced with a complex system consisting of diverse interacting parts that also change over time and – to make things even more complex – the context will change in reaction to us trying to embed something new in it.

There is a growing body of conceptual work helping us understand what it takes to spread innovations. Greenhalgh and Papoutsi (2019) showed how different disciplinary views from social sciences, implementation science and complexity science are supporting us to understand spread. Several frameworks have been developed explaining outcomes, determinants, components and process steps of spread as synthesised by Milat and colleagues (2015). Common themes here are a systems perspective, the rise of complexity science, the increasing prominence of context and particularly enablers and barriers found in the wider context and the importance of an interdisciplinary or intersectoral view.

There is only limited empirical evidence on what specific strategies work to achieve spread. Milat and colleagues (2015) have identified strategies around the engagement with a range of stakeholders, local tailoring of the approach, and the use of participatory approaches. In a recent in-depth qualitative study on spread approaches and activities, we set out to learn about successful spread strategies from those who are doing it on an everyday basis. In England, the National Health System (NHS) has established 15 intermediary agencies, Academic Health Science Networks (AHSN), with the mandate to facilitate the spread of innovations across diverse regional health and social care systems. We interviewed 143 operational and senior management staff at all 15 AHSNs and asked for what worked well for them when spreading innovations between 2018 and 2020.

One size does not fit all – the need for flexible, tailored and whole-system spread strategies

A clear message emerged out of our study: one size does not fit all. AHSNs followed common spread principles that aligned with published spread conceptualisations, such as the prioritisation of the needs of the regional health and care system and following a flexible, engagement-centred and intersectoral whole-system approach. We learnt that it would neither be feasible nor helpful to always apply one particular spread strategy universally across different contexts and different innovations – it seemed more important to pick strategies that are aligned with these overarching spread principles.

The regional(ly diverse) system was the focus of all AHSN spread efforts which highlighted the need for flexible context-directed approaches to fit an innovation into the regional context and meet regional needs. Successful spread strategies were flexible and could be adjusted when the context changed. Interviewees told us about the importance of a thorough assessment of the interrelations between a specific innovation and the local context at the beginning of each spread project. Though seen as essential by practitioners this additional work was often perceived as being under-rated and under-resourced by higher-level decisionmakers.

The focus on the regionally diverse system also meant that AHSNs had to engage with a range of regionally diverse stakeholders. This highlighted another key part of the initial context assessment to identify who the stakeholders are who will need to be involved in spreading a particular innovation. Successful spread strategies focussed on making use of existing or setting up new networks of regional stakeholders while making sure to involve all stakeholders from across different sectors, and from the start of a spread project. This created ownership among the stakeholders supporting the likelihood of an innovation being sustained after the initial spread project ends.

We also found that localised evidence is playing a key role in convincing stakeholders in one region to adopt an innovation that is coming from elsewhere. A key spread activity for AHSNs in this regard is the generation of this localised evidence around the impact that an innovation can have ‘here’ and how to make an innovation work ‘here’ by setting up and evaluating local pilot sites, e.g., one hospital, that is the first to adopt the new data sharing platform in a region. While this activity was seen as essential for spread, interviewees also reported a growing risk of “pilotitis”, the time and resource intensive re-testing of an innovation in each new region.

Conclusion: Think “system”

To mitigate for the increased risk of known and unknown challenges arising from spreading innovations to multiple organisations across a complex geography and diverse population, a successful spread strategy calls for a “systems thinking” approach consisting of the following key activities:

  • Assessing specific local innovation-context relationships;
  • Selecting flexible and tailored spread strategies;
  • Applying intersectoral, whole-system stakeholder engagement activities;
  • Generating localised evidence about an innovation’s added value and fit ‘here’.

Find out more about this study:

Acknowledgements: The study “Review of Adoption and Spread Approaches across the AHSN Network” has been conducted by a consortium consisting of Wessex Academic Health Science Network (Dr Andrew Sibley), South West Academic Health Science Network (Dr Sarah Robens & Dr Sam Tuvey) and the Centre for Healthcare Innovation Research, City, University of London (Dr Alexandra Ziemann & Prof Harry Scarbrough), and has been co-funded by the AHSN Network and the NHS England Innovation, Research and Life Sciences (IRLS) team.

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