Innovation in health and social services – results from the PUBLIN case studies

1. Innovation in health and social services – results from the PUBLIN case studies Paul Cunningham (+ the PUBLIN Project Team) PREST University of Manchester

2. Introduction • PUBLIN – comparison of innovation in public sector versus private sector • Case study approach (11 ‘innovations’) • Perceptions and definition of innovation in the public sector • A common analytical framework – • Drivers • Facilitators • Barriers • Findings & Lessons

3. Perception, definition & interpretation of innovation • Concept of innovation accepted in national public sector context • Definition works - “deliberate change of behaviour at the level of institutions that includes a new or improved service, process, technology, or administrative tool” • Concept often applied in context of “change” “modernisation” and “problem solving” • Concept is applied across all types of innovation (technological, yes, but also… process, organisational, etc.)

4. Study Teams & Case Studies Social sector: • Ireland: (University College Cork) • “The Pensions Retirements Savings Account” • Israel (University of Haifa): • “Regional Resource Centres of Special Education” • Lithuania (Mykolas Romeris University, Vilnius): • “Innovation in services for the elderly” • Norway (NIFU STEP): • “Innovation in home-based services for the elderly” • Slovakia (Comenius University, Bratislava): • “Residential care for the elderly”

5. Teams & Case Studies Health sector: • Ireland: (University College Cork) • “Innovation in the provision of home help services in the Southern Health Board area.” • The Netherlands (University of Maastricht): • “Development and implementation of clinical pathways in the psychiatric hospital Vijverdal.” • Spain (University of Alcala): • “The adoption of innovations (Digital Radiology technology and Main Ambulatory Surgery processes) in a public hospital in Spain.” • Sweden (VINNOVA): • “Hospital-Managed Advanced Care of Children in their homes.” • United Kingdom (Manchester Metropolitan University): • “Patient-Oriented Education Systems for Diabetes” • United Kingdom (The University of Manchester): • “NHS Direct: An Innovation in Social Trust – Remote access to public healthcare and the health service”

6. Common issues in the public sector • Demographics: an increasingly ageing population • Increase in chronic diseases & long-term conditions • Integration of social groups into mainstream / decline of institutional care • Patient empowerment / personalisation of services • Decline in public trust in expert opinion / emergence of learned customers • Consumerisation • Privatisation and new public management • Shortages of healthcare professionals / diversification of service providers

7. Analytical framework: Barriers and responses (1) • Size & complexity: • phased introduction, pilots (UK1, SK) • local level implementation & push (UK, SK) • responsiveness to local conditions and needs (UK2) • thorough consultation with stakeholders (IE.s) • “Heritage and legacy” • strong top-down drivers (UK1) • use of local “champions” (UK1) • engagement with stakeholders (UK1) • targeted removal of functional silos (NL) • local problem solving and open remit, flexible culture (SE, UK1 ) • role of NGOs (SK, LI)

8. Barriers and responses (2) • Professional resistance • integration with local systems / engagement of stakeholders (IE.s, UK1) • large scale consultation (IE.s) • “agents of change” (SK, IL) • demonstration of benefits (ES, UK1) • customer empowerment (UK1) • threat (!) (NO) • Risk aversion • top-down driven (upward shift of responsibility) (NO, SK, UK1) • piloted introduction (IL, SK, UK1) • strong quality control systems (UK1) • local level feedback loops (IL, SK, UK1) • local responsiveness (UK1)

9. Barriers and responses (3) • Public accountability and high profile • ministerial responsibility (UK1) • local flexibility (UK2) • strong feedback mechanisms (UK1) • strong consultation and consensus (IE.s) • Unclear outcomes/need for consultation • process of ex ante research, review and evaluation (ES, IE.h, NO, SK, UK1) • ongoing consultation & feedback with stakeholders (IE.s, UK1) • piloting (IL, SK, UK1) • Pace and scale of change – “innovation fatigue” • rapid introduction (promotion of dynamic culture?) (NL, UK1)

10. Barriers and responses (4) • (Lack of) capacity for organisational learning? • top down initiatives to promote general culture of learning (UK1) • strong feedback loops & open remit (UK1,UK2, SK, LI) • use of champions/entrepreneurs (SE, SK, LI) • Public/end-user resistance • generally good uptake/high public acceptance (if involved)… (IE.s, IL, LI, SE, SK, NL, NO, UK1) • …but better in some social groups than others (UK1,UK2) • demonstration of benefits (ES)

11. Barriers and responses (5) • Absence of resources • acts as stimulus for change… (+/-SE, IE!!) • ex ante demonstration of potential cost benefits (ES) or incentives (UK2) • Technical barriers • development of clinical assessment software (UK1) • lack of remote monitoring technology (SE)

12. Drivers & Facilitators (1) • Problem-orientated driven • systemic crisis – multiple solutions required (IE.s, NO, UK1,UK2) • specific problems (IL, LI, SK) • general efficiency or care needs (ES, IE.h, NL, SE) • Political push • high level endorsement/national impetus (IE.h, NL, SE, UK1, UK2) • Strong culture of review • use of ex ante consultation (IE.h, IE.s, UK1) • evaluation and monitoring, local & stakeholder feedback (IL, NO, SE, UK1) • staff engagement (LI, SK)

13. Drivers & Facilitators (2) • Support mechanisms • external agencies: • workplace partnerships (IE.h) • clinical pathway promotion (NL) • NGOs (SK) • Modernisation Agency (UK1)? • funding (IE.h, NL, SE, UK1) • input from key officials (SE) • networking (IL, LI, NO, SK)

14. Drivers & Facilitators (3) • Capacity for innovation • role of entrepreneurs/champions (all) • open remit – problem solving & stakeholder engagement • further innovations, new applications & linkages with complementary systems • Competition drivers • performance targets/pseudo-markets? • inter-organisational competition? • client satisfaction • Technological factors • new technology (ES, SE, UK1)

15. The nature of public sector innovation • It involves interaction with the public • It is complex (with multiple stakeholders, locales, contexts… and outcomes) • It requires adjustments of relationships, norms and behaviour • It is systemic – promotes/requires further innovation

16. Some lessons? • Pluralism of approaches • Openness to ideas • Ability to seize opportunities • Key role of champions / entrepreneurs • Teamwork & independent thinking

17. Some more lessons? • Engagement of stakeholders & ongoing dialogue • High degree of reflexivity • Demonstration of utility • Pilot process • Generate recognition and support • Retain momentum

18. End of Presentation…thank you!…merci!…danke!