Implementing and scaling up evidence-based innovation is key to addressing health and social care challenges, and innovation research is core to a business school. If we consider the potential ways to address the challenge in health and social care from an innovation research perspective, then, based upon research carried out within Warwick Business School, we might consider the following.

Innovation is a process, encompassing an “innovation journey” through which new practices and structures are “diffused” by key actors to improve organisational performance. “Diffusion” is an interesting descriptor applied to innovation; it captures the dynamic nature of the innovation journey, its spread from the early adopter to other organisations and contextual influences upon the adaption of innovation. Much of the research on innovation has been criticised for focusing on its early stages, such as the development of an innovation culture and its local implementation, with the sustaining and diffusion of innovation much less researched. Innovation and its diffusion prove challenging to manage because it is nested in a complex ecosystem, the components of which may diverge rather than come together. Understanding and managing the innovation journey thus requires multi-level study that identifies drivers of diffusion of innovation across national, regional and organisational contexts, as well as experiences of adaption of innovation within contexts.

Early research focused upon technical or economic benefits of the innovation itself, assuming that successful, evidence-based (‘best practice’) innovations would diffuse en masse, if only users could be made more aware of their benefits & persuaded to adopt them.[1] However, this model is inadequate. Later research carried out by Warwick Business School focuses upon social aspects. Innovations spread through social networks when they come to be perceived as legitimate, or even ‘must-have’, aspects of organisations. At the extreme, diffusion of innovation is driven by ‘bandwagons’ and ‘success stories’ that have less to do with performance benefits and more to do with actions & vested political interests of particular professional groups. Commonly, innovation that diffuses fits with preexisting organisational and professional practices, rather than radically deviating from them, regardless of potential benefits. This means that some innovations spread even where their performance benefits are questionable; they are ‘hollow’,[2-4] like derivatives or new generation opoids in the earlier piece by the ARC WM Director.

Alternatively, innovation may be driven by the regulator, such as the Care Quality Commission (CQC) or Office for Standards in Education, Children’s Services and Skills (Ofsted), with their spread limited even where they are meaningful and there is a strong evidence on Innovation Applied to Health and Social Care 6 base surrounding their benefits and use, as shown in Warwick Business School research about the often patchy uptake of NICE guidelines.[5-6] Typically policymakers and managers may want to ensure innovation remains faithful to its original, evidence-based origins, which determine its efficacy. This seems the basis of ‘evidence-based practice’ encompassed within social care and NICE guidelines. However, viewing innovation as a process leads us to question these assumptions.[7]

In essence, we need to understand whether, and what kind of adaption of innovation as it diffuses is necessary, and what affect this adaption has on outcomes. We need to understand trajectories of innovations, their adaptions, and what makes them meaningful or hollow. Adaption in the face of an unpredictable innovation process poses particular challenges for management and organisation. Problems, unintended consequences and resource constraints inevitably occur along the journey as innovations are adapted to new organisational contexts. Innovation cannot be managed, then, through a step-by-step set of plans made upfront. Managers must be receptive to the possibilities opened up by innovations as they diffuse and are adapted, while at the same time being sure that clear benefits are realised. Shared leadership across professionals & managers in different organisations is likely to prove crucial in diffusion of innovation, with the source and leadership of innovation commonly coming from frontline professionals rather than managers.[8]

Graeme Currie, ARC WM Organisational Sciences Theme Lead

References:

1. Rogers EM. The Diffusion of Innovations. New York, NY: Free Press, 1983.
2. Lockett A, et al. The influence of social position on sensemaking about organizational change. Acad Manag J. 2014;57:1102-29.
3. Scarbrough H, et al. Diffusion in the face of failure: The evolution of a management innovation. Br J Manag. 2015; 26(3):365-87.
4. Swan J, et al. Mobilizing Knowledge in Healthcare: Challenges for Management and Organization. Oxford: Oxford University Press; 2016.
5. Grove A, et al. The barriers and facilitators to the implementation of clinical guidance in elective orthopaedic surgery: A qualitative study protocol. Implement Sci. 2015;10(81).
6. Spyridonidis D & Currie G. The translational role of hybrid nurse middle managers in implementing clinical guidelines: Effect of and upon professional and managerial hierarchy. Br J Manag. 2016;27(4):760-77.
7. Radaelli G, et al. The role of managers in enacting two-step institutional work for radical innovation in professional organizations. J Prod Innov Manag. 2017;34(4):450-70.
8. Currie G & Spyridonidis D. Sharing leadership for diffusion of innovation in professionalized settings. Hum Rel. 2019;72(7):1209-33.