Pearson Matthews - Innovation Consultants

Public Service Review log

Making innovation a weapon of mass change

This article for Public Service Review Magazine was published in January 2010

 

‘Innovation will save our health system’ how often do we hear that from ministers or the Department of Health and other senior health figures? How else will we pay for the demographic shift that adds 1% or a £1billion to annual healthcare costs or meet the cost of rising obesity that, according to a recent Foresight report, could reach 50% of males by 2050. Obesity is currently estimated to cost the UK £10 billion if one factors in the cost of type 2 diabetes and heart disease, alcohol and substance accounts for another £2 billion and rising fast.
Innovation is heralded as weapon of choice to fight these rising costs, helping us build a more patient centric system. It is true that over the last decade innovation has managed to generate significant savings by changing patient pathways. But can it continue to deliver as anticipated? Or are we entering a phase of diminishing returns, facing the possibility that innovation may not deliver as we hope? I don’t believe we have exhausted innovation; we just need to learn to use it in a different way.
We are suffering from innovation overload; the current economic climate is causing industry to describe every marginal iterative improvement to device or service as innovation. Industry and academia is obsessed by the commercial allure of innovation, buoyed by the huge commercial success of a few truly innovative health devices. This obsession is causing UK academia to spin-out nearly three times more companies per £million of research funding than the US. Yet the INSEAD Global Innovation Index 2009 ranked the UK a disappointing 11th on university-business research collaboration success.
The fact is that over the last decade a handful of key innovations, such as joint replacement, point of care diagnostics and keyholes surgery have made a significant impact, spawning new medical sectors and proving hugely profitable. Keyhole surgery is one of the most impressive. The ability of a stent to expand the wall of an artery, delivered by a minimally invasive catheter, was an immediate success because it radically changed the treatment pathway of heart disease and therefore vastly reduced its cost.
Another example is vacuum wound healing technology, its ability to cut healing times projected KCI to a billion dollar turn-over in just a few years. The same applies to bipolar tissue ablation; devices that allow low cost arthroscopic intervention with similar immediate health improvement. We know breakthrough innovations prove highly profitable, but the pattern shows that their success is mainly due to a capacity to shorten treatment pathways.
The problem is these few major successes have made innovation seem like the National Lottery, you too might be lucky and invent something that creates a step change and unlocks untold wealth. For that reason a sea of academic projects, surgeon inventors and hungry companies from inside and outside healthcare focus on innovation. They relentlessly promote new technologies hoping their idea will be next big thing. We must not quash this hunger because amongst them will be a few significant innovations. But most are likely to be iterations that shave minutes off a procedure time, or reduce risk slightly, or do something we can already do but do it differently.
We need to shift our focus onto innovation that has the potential to create step changes. It can be challenging to decide what will make a big difference but any new idea should be subjected to robust assessment before committing time and money to its development. It means asking ‘exactly where does this innovation make a difference’ before asking ‘what does it do’? This is vital information yet I am often presented with ‘innovative’ technologies where no attempt has been made to explore their potential.  When you apply tough scrutiny, many turn out to offer only minimal improvement over existing techniques, not innovation.
So what conclusions can we draw? Firstly, that it is now 2010 and healthcare has becoming highly sophisticated, most markets have matured and patient pathways have become wrapped up in procedure and system and are linked to the environment in which they are delivered. Innovation needs to broaden its focus to take account of this.
Secondly, the engine of invention is industry and academia, yet much of what they invent is iteration not innovation. Health policy makers need to be prepared to guide academia and be clearer about the sort of innovation they want. Thirdly, more robust mechanisms are needed to help us sift innovation and separate the significant ideas from the mass of device iterations. And lastly, we must accept it takes a lot of iterative innovation to save a £20 million, so to save the £20 billion a new approach might be needed.
We need to stop thinking about innovation as an adjective and treat it as a verb. To innovate should be seen as a weapon of mass change, with the power to level the playing field, change the rules of engagement and alter the landscape. To be effective innovation must be driven from the top down, for the obvious reason that the systems and pathways of health are dictated from the top. It may challenge senior health officials and policy makers but it requires them to be willing to engage with innovation. It can be difficult to get key individuals away from day to day pressures and encourage them to think fundamentally about health delivery. But if they simply manage to categorise short, medium and long term time frames, and identify a scope for innovation within each, that is an excellent starting point. It is then far easier to delegate responsibility for exploring options within these frames of reference.
I want to give an example of looking innovatively at fundamental issues. An eminent professor recently described a fabulously successful treatment for obesity, diabetes, Alzheimer’s, osteoporosis, COPD and many other diseases. He built it up as something cheap, easy to administer, involved no pharmaceutical intervention and highly effective. Then he asked me not laugh and said it is exercise.
I realised that we do indeed know exercise helps all these diseases. So the innovative step is working out ways to make it a credible treatment rather than a lifestyle choice. I thought about how we might rebrand exercise as a positive medical treatment? Give it on prescription with proper dosages and strengths, provide effective support by GPs, engage patients with detailed ongoing assessment plans, and set up specialised outpatient wings devoted to exercise; they are called gyms and quite cheap. Happily, technologies to monitor activity and manage weight are emerging right now. If patients felt they were being prescribed a credible medical treatment and were shown that the alternative is more complicated, less effective and may have side effects they might be encouraged to comply.
This example is intended shows that there is a more holistic way to use innovation. Surely making this idea work is less about funding, more a question of getting an entire PCT or SHA behind the idea with DoH support. It does not stop there; research shows that to succeed nationally we would also need to rethink our built environment, the workplace and transport.
The message I am sending is stop thinking that the way we currently use innovation is adequate. Instead, encourage health policy makers to engage with innovation as a way to help them think big. We need this high level engagement if we want to drive real social and service innovation that allows our health system to meet the challenge of the next 10 years.