How To Drive Innovation In The NHS
This interview first appeared on the Innovation Enterprise Channel in April 2018
Ahead of our Chief Innovation Officer summit in London, April 25 & 26, we spoke with Dr Tammy Watchorn, Head of Innovation at National Services, NHS Scotland, about innovation in the public service sector.
Dr Tammy Watchorn started her working career in medical research and quickly realised she didn’t have the patience for ‘waiting for things to grow’ & doing ‘the same experiment over and over’. She soon found her niche after moving into NHS, initially as a project lead before moving on to big organisational change programmes. Getting bored quickly proved to be an asset as wanting to learn lots of new things (at speed), learn from failure and trying out the new and untested resulted in her being recruited to tackle complex problems across the organisation. She is currently driving, supporting & enabling innovation for health and wellbeing across Scotland where she spends much of her time as a virtual QUBOT.
Does working within the constraints of public service affect your ability to innovate?
Yes and no. The public sector is well known for its bureaucracy, traditional hierarchies, governance and risk avoidance. All of which can slow down and block innovation activity. But it also offers a chance to try and change some of this, some really meaty barriers that need innovative solutions to knock down or find innovative solutions to go around them. Many of the barriers are perceived, handed down from previous managers, and are habits rather than rules set in stone. And starting to unpick some of this in an innovative way can have a much bigger positive impact on the organisation and staff than just innovating a specific service solution. It enables staff to feel comfortable challenging barriers and creating new solutions and starts to shift the organisation into being more innovative as a whole.
How do you encourage a culture of innovation at NHS Scotland? Do you have any tips on creating a workplace that encourages innovation?
For me its all about creating the right environments with a choice of tools to use. We have done lots of things for all levels of staff, but mostly I think it is about creating new spaces and environments to enable people to work in a different way, to feel safe and supported in thinking creatively and challenging the norm.
We have done simple things like blind coffee dates, where people are matched randomly and meet for coffee, sparking many new ideas and collaborative working. We've had Friday Film club (a TEDx followed by Q&A) to encourage new thinking and networking.
At the other end, we have had immersive problem solving "sand pits" over 3-5 days, hosted in more creative spaces as a change of environment can have a massive impact on thinking and behaviours (and, it's interesting what people wear, they get more casual as the sand pit progresses!).
And finally, and probably the most successful, has been the use of QUBE, run by Pentacle the Virtual Business School. This has enabled us completely change HOW we work to change WHAT we do. Its a safe, neutral, non-hierarchical space full of tools to do things at speed, to support innovation and creativity, and encourages collaboration across boundaries, geographies, and organisations. We have used this environment for prototyping, ideation, agile projects, leadership, training and a variety of workshops. A recent virtual project took an age-old Scotland wide problem and in just 3 weekly 1 hour sessions with a national group of surgeons we had alignment on a solution and a working prototype developed... now that, for me, is a real culture of innovation...
Do you think established organisations should be aiming for a startup mentality in order to embrace innovation?
This is an interesting question and I think there's definite merit in it but I'm not sure how easy it is to do in reality for big complex organisations. We have tried to adapt some of the methods suggested in Kotters XLR8, but it's hard to shift people away from needing KPIs and progress reports. For example, I'm often asked to demonstrate the 'benefits' or 'health outcomes' of what I do which can be really hard. I tend to be very much at the early stages of facilitating around problems and ideas, getting new collaborations off the ground prototyping. All of these will hopefully lead to health outcomes but it could easily be 2 years before an idea is developed and adopted into BAU and starts to demonstrate the benefits (and I will have long left the process by then).
I also think there is a risk in adopting the startup mentality in that this is often done within one team (ie. a new team set up with the permissions to act as a startup ) so the innovations, thinking, way of working etc. become siloed, something that's done 'over there' and can exclude or easily disengage the rest of the organisation.
For me, it's all about creating a shift in how we work as an organisation, so innovation becomes part and parcel of what we ALL do, part of our culture, and therefore becomes sustainable
What are the biggest traps organisations fall into when it comes to implementing an innovation program and how can they be avoided?
For me, not calling it a programme is a good start (and don't have a 'culture change programme' either). Back to points made earlier, I have been asked, in the past, to produce giant charts of what I'll innovate and by when. It's not a job for someone to do, it's not a brief for someone to write or a set of agreed upfront projects to deliver. Using traditional methods and language can make it much harder for people, teams, and organisations to think about how you might do more innovations in an innovative way.
Also, don't implement a linear process to capture and review ideas. Innovation funnels can: end up knocking back ideas that seem a bit 'whacky' and approving ones that sound familiar so you end up really with lots of 'improvement' projects: not really start with what problems are you need to solve (but ideas people have had to change their bit of the workplace); demotivate staff who's ideas are rejected; don't really tackle the organisational barriers that may stop the innovations (demotivating staff who's ideas are accepted).
For me, it's more a set of principles, supporting tools and ways of working to enable the real problems to be identified, new ideas to be thought of; collaborations to be developed for prototyping and developing new solutions and ensuring the organisation is ready to enable the innovation and the blocks have been removed.
We need to be able to try and fail (and learn from the failure). Of course, there needs to be an element of governance, but most people can be trusted to do the right thing so don't overly worry about this. When you're doing innovation, you are much more likely to properly de-risk something that is entirely new, so the risk of something going horribly wrong is vastly reduced. The idea you have may, of course, not quite work out, but by using different processes and tools suited to iterative development you are likely to know early what ideas are likely to fail and cull them before you go too far (and of course learn from it).
What do you think will be the next disruptor in the NHS?
Good question. The NHS isn't great at being early adopters and I know AI is the new 'buzz word' so I'm sure that will come into play soon, but it's back to trying to work out what the problem is and how we might use technology to overcome the problems. One of our biggest challenges just now, and most certainly in the near future, is the numbers of trained staff vs demand. This means we have to really think about how services are delivered. And not just within the NHS, but across Health and Social care, so can meet the needs of individuals for health and well-being rather than focusing on treatment and cure. This will require a radical rethinking of service delivery, much more use of digital technologies, much more support within communities and away from direct health services, and much more about individuals playing a bigger role in their own health and well-being. The technology solutions, I think, are already there or will be there shortly, so I think it's about transforming how we think and how we work. Transforming ourselves so we are much better placed to accept and adapt to new ways of service delivery that will be much more digital and person/patient driven. And it's a lot harder to shift people than it is to adopt a new technology solution... so that needs some real disruption
How do you prepare for disruption?
As Professor Eddie Obeng says, go slow to go fast - spend heaps and heaps of time engaging, listening, coaching, training. Not just communicating (which is one way). Find a way of getting turkeys to vote for Christmas. Get everyone aligned. Let everyone collaborate in some way. Once you've done that you can go super fast implementing your solution as everyone will be champing at the bit for it - they will own it and feel they had a role to play in developing it
How is the nature of innovation and organisations' approaches to it set to evolve over the next five years?
I really hope it becomes something we just do and it's not seen as a separate thing. That we build in new ways of working that are adaptive to a fast-changing world. For the public sector, I really hope it means we move away from traditional hierarchies, job descriptions, fixed teams and have a more flexible and adaptive workforce that uses the skills of the people where they are needed to ensure sustainability of innovative thinking and solution delivery. That might not sound exciting to some, but the innovative apps or technology is the easy bit, having a new world organisation is however much, much harder...