How the Seven Spread and Adoption Principles Work in Practice: the Continuing Healthcare Improvement Collaborative case study

The spread and adoption of innovation and improvement doesn’t usually occur easily or routinely in normal practice. Looking to examples of where it does happen in practice can provide useful insights.

In this blog Kate Pound and I explore how the seven interconnected principles for spread and adoption and the role of system convening apply to the success of the Continuing Healthcare Improvement Collaborative (CHC). NHS continuing healthcare is a package of care arranged and funded solely by the NHS for some people with long-term complex health needs and is provided outside of hospital.

We build on our first blog which described how the CHC developed a successful new model for spread and adoption of innovation and improvement. The model was based on wide and early involvement of people (figure below).

The experiences in both blogs are from Kate's time working with us in NHS Horizons. Kate (@KateSlater2) now works as an Improvement Manager in the Emergency Care Improvement Support Team (ECIST).

The Seven Spread and Adoption Principles

These seven interconnected principles were developed from published knowledge and practical experience to help leaders enable the spread and adoption of complex innovation and improvements. The resulting seven interconnected principles for spread and adoption are shown in the figure below.

Kate compared these principles to her experience developing and leading the CHC model and shared with me the following:

Complexity – spread and adoption in health and care is often a complex activity

Complexity in the health and care system is characterised by unpredictability and interconnectivity. The complexity of our health and care system means we need to be flexible and prepared to adapt. It is underpinned by relationships. The result for leaders and staff is the need to be able to work with constant change and emergence and the challenges such a situation produces.

The CHC worked across systems, where the unit of activity and engagement was defined as the local authority and the CCG (Clinical Commissioning Group), at local and national levels so the work was definitely complex. Understanding and acknowledging this complexity and how to work with it was essential for success.

This CHC model worked well in its complex context as it offered a model that was able to be adapted, and involved lots of connections based on personal interactions and relationships. It allowed for emergence with key individuals responding flexibility when faced with unpredictable situations.

Details and other case studies illustrating working with complexity are offered in previous blogs and videos here.

Leadership – An enabling leadership style is needed

Kate, as the CHC lead, had a key role in convening and connecting across the systems. Working in an enabling way, such as system convening, is described in more detail later in this blog.

This CHC model offers dispersed leadership and ownership by the creation and role of the Development Group. The Development Group members were the innovators of the new ways of working and were all heavily involved in the programme learning, testing and change

Individual - The perspective of the individual is pivotal

The work was driven by the passion, commitment and energy of key people and subsequently the wider community. The work was patient focused and met the needs and expectations of the participants and supporters. There was widespread involvement and extensive peer support within the CHC community. This peer to peer support provided emotional help, increasing staff resilience, and enabled knowledge sharing and learning. Patient input to this initiative was from the NHS England patient experience group.

Benefit - Focus on the benefit rather than the innovation, the ‘why’ not the ‘what’

NHS Continuing Healthcare was seen as an important topic with the opportunity and need to deliver quality improvement and cost savings around ‘Better outcomes, Better experience, Better use of resources’. This created a shared narrative that helped build a ‘pull’ for this CHC work.

Adopter focus - Increase focus on role of adopters to energise and spread through commitment and agency

Fundamental to the model is the belief that people ‘spread what they create’ so co-production mechanisms were used to enable product development with front line staff. This approach enabled emotional energy, commitment and trust to be built up over time. The inclusive nature of the model generated energy and maximised agency for change.

Networks - Networks build communities, energising and connecting individuals

The development and activity of a network or community was fundamental to the CHC model. The CHC built an active virtual Improvement Community with more than 1,000 participants. The community supported the core groups of the CHC community (the Development Group and Test and Spread Group) with most of the interaction and work delivered virtually. By involving the Improvement Community from the start, the members were receptive and ready to the adopt the changes so subsequent spread happened rapidly and extensively. A sense of urgency was created by national team members through the use of public narrative - sharing stories of the people involved with and impacted by the community. Following the end of the CHC the digital community is sustained via platforms such as WebEx, and aFacebook page.

Learning - Build a learning system and habit of learning, sharing with and seeking knowledge from others 

The flow of knowledge and experience, with two-way learning across the whole system, was integral to the CHC model. Active peer to peer sharing and learning was encouraged as the regular WebEx was structured to include ‘share an idea’ or ‘ask for help with something’. This open, collaborative approach enabled problem solving together.

‘The successful approach we took in our work reflects well the seven interconnected spread and adoption principles’

Systems convening and the CHC model

Systems convening to enable spread and adoption can be described as:

• creating and utilising adaptive spaces to increase connections, collaborations and knowledge flows across boundaries enabling spread and adoption of innovations
• supporting development of relationships, trust and learning partnerships and networks
• strategically coordinating spread across the local system helping focus on innovations of local system benefit
• supporting spread across a system and enabling early involvement of adopters helping to build a shared purpose

Kate, as CHC lead, worked convening and connecting the systems and also across the whole of the collaborative. Kate believes key to her success was:

• being one point of contact for the Development Group, a ‘super-connector’ who knew the people active in the work
• ability to ‘manage up’ and ‘manage down’
• forming key relationships, but notes that this takes time
• enabling a narrative to develop which translated the aims into something meaningful for the staff
• managing the evolving narrative over time

More information on complexity, system convening and the seven spread and adoption principles is available on the NHS Horizons website including the first CHC blog Planning For Spread and Adoption From The Start: A Novel Model For Success.

If you're interested to read more there are previous blogs and further blogs to follow. Please do subscribe to this blog and follow @DianeKetley @HorizonsNHS, #nhsspread.

Glossary

Adaptive space – temporary safe [virtual] space at the interface of normal business and the innovation where through developing relationships, addressing tensions, shared learning and working with emergence, spread and adoption can be enabled.

Agency - the ability of an individual or a group to choose to act with purpose