Skip to main content Skip to navigation

Short Project Descriptions

Show all news items

Improving Evidence-based Innovation in Social Care: A Methodology for Values Alignment

Background:

 

Innovation is needed more than ever as social care demands grow. It is widely accepted that innovation should be based on best available evidence of efficacy. However, evidence alone does not guarantee uptake, with many evidence-based innovations failing to spread. Innovation processes, particularly in complex, multi-stakeholder contexts like social care, are challenged by scarce resources, but also by competing values and interests of stakeholder groups. Whilst existing scholarship tells us much about the how stakeholders overcome such challenges, it says less about why stakeholders engage in innovation in the first place. We propose that ‘values alignment’ - the extent to which the values of an innovation fit with those of key stakeholders - is key to stakeholders’ willingness to engage with an innovation process. Values influence stakeholders’ preferences, actions, and commitments to desired outcomes. Where innovations (new models of care) embody stakeholders’ values, change becomes possible. Conversely, models of care that run counter to stakeholder values may spread less successfully (Radaelli et al., 2017).

Our study unpacks the role of values in innovation and the drivers of values alignment across an innovation process. Our research question is “How do model and stakeholder values come to align to enable innovation in social care?”. We focus on innovation in homeless services. Homeless service provision is intensely challenging as it occurs at the intersection of shelter, health, social care and other support needs, so spanning different professions and organizations/sectors, and often entailing high-stakes and scarce-resources. Homeless service users suffer much poorer health outcomes, and much higher mortality rates, than the wider population, despite being major users of health services.

To explore values alignment we first conducted a systematic literature review on the topic. We then explored two cases of innovation in homeless service delivery. Our findings demonstrate the crucial role of values alignment in innovation and reveal the processes by which stakeholders’ values come to align with new ways of working.

Policy and Practice Partners:

 

NIHR Research for Patient Benefit and Research for Social Care funded the research.

The Collaborating Centre for Values-Based Practice, St. Catherine’s College, University of Oxford and

Homelessness Oxfordshire helped to design our research in line with the views of homeless service users and providers. HomelessLink and the European Observatory on Homelessness helped us engage national and international stakeholders.

 

Co-Funding partners:

This research was funded by NIHR RfPB. Participating case partners (anonymised as per confidentiality agreement) lent funding-in-kind via their time devoted to the study.

Aims and Objectives:

 

The overarching aim of our research was to understand why certain innovations spread, while others do not, in social care organizations. More specifically, we aimed to investigate the processes by which stakeholders’ values come to align, or not, with the values embedded in new models of care within homeless service organizations. Our aims were to be achieved via the following objectives:

1. Review literature, policy, and organizational documents.

2. Understand, through two case studies of innovation in the delivery of homelessness services, how service providers interpret model values and how this relates to their own values.

3. Compare and contrast findings across cases to document how values come to align within the innovation process.

Methods:

In brief, in our systematic literature review examined published papers that explicitly addressed ‘care’, ‘innovation’ and ‘values’ and followed the Denyer and Tranfield’s (2009) CIMO framework for inclusion as follows:

· Context – setting involving social care

· Interventions – innovation directed at improving outcomes

· Outcomes – demonstrated impact of the innovation (positive or negative)

· Mechanisms – how/why/if values impact

In addition, we focussed on papers published in English in the previous 20 years. Our search returned 1241 papers, narrowed to 34 with criteria applied. These focussed on different episodes of the innovation process, with 20 addressing development/design, 10 addressing implementation and 4 addressing diffusion/spread.

Next, we conducted qualitative case studies with two homeless services in England engaged in innovations aimed at improving person-centred care, which entailed a shift in values. Specifically, we conducted interviews with homeless service providers to understand their experiences of the innovation process, the importance of values and how they came to align. Interview data were supported by secondary case data (e.g. innovation models, project timelines etc.). All interviews were held virtually as the onset of the COVID pandemic coincided with our fieldwork. We had initially planned to conduct service user interviews and observations but this was due to the pandemic and remains a priority for future research. Rich case descriptions were presented to key informants for validation. Cases were then compared using thematic analysis to draw out role values played within the innovation process and mechanisms that helped (or hindered) values alignment.

Main Results:

The literature review found that values alignment was driven by clarity and explicitness around values, as well as effective relationships, leadership, and involvement, during the development and implementation of innovation. The literature also suggested that the same innovation can impact on stakeholders’ perspectives, identities, and emotional commitments differently within the same context. Finally, the sustainability of innovations is guided by previous values alignment, whilst participation in innovation work seems to shape stakeholders’ values and their commitment to

implementation.

In our cases, a clear value expressed in the innovation in both organizations was ‘client agency’ (i.e. that service users would have the right and means through which to fully participate in decisions about their own care and that their own preferences regarding quality of life would be centrally involved). Alignment to this core value was, most clearly, manifested through peer advocacy and co-production activities, both of which centred on the meaningful engagement of the communities being served and those with lived experiences. Co-production and peer advocacy not only aligned with the underlying value for client agency embodied within the models of care being introduced, but also drove client agency forward by empowering individuals to become meaningfully and authentically involved in planning, design, and delivery of the innovation. In addition, a focus on relationships and a strong sense of identity with the innovation influenced, and was influenced by, values alignment in both cases during innovation work.

 

Conclusions:

 

Our study suggests that innovation processes have better outcomes if values are aligned among stakeholders and innovations. We detail key enablers of values alignment across different episodes of the innovation process. Our cases reveal the importance to values alignment (here, around client agency) of collaborative relationships and identification with the innovation, and also how alignment is driven by the practice of ‘co-production’. Co-production is typically associated with sharing/mobilizing knowledge, but our study shows that it is equally key to values alignment. Our study moves beyond discussions on the importance of values to understanding how stakeholder and innovation values can come to align and why stakeholders engage in innovation.

 

Implications for Implementation:

 

This was an exploratory study (NIHR RfPB Tier 3). The findings produced provide a first step towards guiding future research and practice on how values alignment influences innovation and the practicalities of achieving values alignment. This complements the existing research base on implementation methodologies. Rather than having a one-off effect (e.g. from evaluating a specific intervention), our research findings should strengthen social care innovation across settings, over time. Case collaborators have also had the opportunity to reflect on their own practice.

 

Protocol:

 

See attached

 

Publication:

 

Forthcoming: Swan, J. Manning, R., Logan, K. and Bharatan, I. The role of values-based practice for healthcare innovation. In Burgess, N and Currie, G. Sustainable Healthcare. London: Palgrave MacMillan.

Mon 13 Sep 2021, 13:53 | Tags: Organisational Science Jacky Swan