Innovation, Dandelions and Orchids

This week has been a real mind bender, and I thought I'd share my confusions and perhaps a little of the clarity which seems to be emerging...

How can we consider innovation?

Before we get onto how we are approaching innovation, it seems to me that we need a common vocabulary to refer to when we discuss it. I offer two different perspectives.

Firstly, it seems helpful to me to recognise that there is a conceptual lifecycle, where the very twinkle of an idea is discovered, then a concept is considered and a thing is invented. Once we have a thing, we can shape it, try it out, and evaluate its performance. If the thing survives this first contact, then the next stage is to consider how such a thing might be implemented and to try an implementation at a pilot scale. This proof of concept will demonstrate a wider applicability and sketch out the benefits and return on investment. If the ROI is good and a programme of wider use is affordable, then we may proceed to implementation and widescale adoption.

Now, where in this lifecycle does the concept of innovation lie? This is admittedly a somewhat philosophical question, but it matters.

If we define innovation as "any creative response to a challenge" (as in https://www.strategyunitwm.nhs.uk/sites/default/files/2018-12/Innovation%20%26%20evaluation%20proposition%20%28final%29%20v1.pdf) then frankly everything we do in our day to day lives is innovation.

What if we adopt the ISO 56000:2020 definition: "a new or changed entity, realizing or redistributing value". This, it seems to me, is genuinely useful because it positions innovation as a question of value creation and change. Yet once again, it provides such a high level position as to be hard to reflect on in our day to day existence.

Secondly, we could adopt a framework of reference for innovation. From my reading, I favour the model from the Austrian Economist Joseph Schumpeter. His work on the destructive impact of innovation and the power of technological discontinuities seems to me to offer a real insight into how Generative AI might disrupt our health and care systems. I therefore consider innovation through five

lenses:

The wording on the above chart doesn't always feel very "healthcare", but I've been noodling on these five modes of innovation for some time and they seem to stand up to some scrutiny and have real relevance to our work on innovation in healthcare today.

Specifically, I've been thinking about how we are doing in the NHS on these five innovation modes. Sadly, I think we'd be getting a "C-" on our end of term report card. We'd be doing pretty well on clinical product innovation - the NHS (and related academia) has a long and proud history of inventing medical technologies - let's give that a solid "A". But on the remaining four modes of innovation, I'm afraid our performance has been underwhelming and we need to think much harder. [Do you agree?]

I wonder why?

Dandelions and Orchids

In her excellent book "Quiet: The Power of Introverts in a World That Can't Stop Talking", Susan Cain writes about how sensitive children can be considered using a botanical analogy. Some children are naturally resilient and will thrive in even harsh circumstances (the dandelions) whereas some are more sensitive, requiring constant and careful nurturing but with the right circumstances they can blossom in remarkable ways (the orchids).

I've been wondering then, whether innovation in the NHS is a "dandelion" or an "orchid". I conclude that generally its an orchid struggling in unfertile soil. What then might the conditions need to be for the orchid to blossom? Here goes... we need:

1) An organisation culture which visibly values controlled and measured experimentation. With falsifiable hypotheses (thank you Karl Popper) and a benefits / outcomes assessment planned in from the start.

2) We need to value local initiatives for innovation which put the citizen at the centre. Innovation becomes value when it is put into action and used in earnest and at scale. We don't need a central innovation function we need local innovation champions supported by an innovation nurturing culture.

3) Recognition that Innovation comes in many forms not just product. We need new organisational constructs (See "Reinventing Organizations: A Guide to Creating Organizations Inspired by the Next Stage in Human Consciousness" by Frederic Laloux ) and new ways of serving our customers (patients / clients / residents / citizens ...)

4) Resources allocated to stimulate innovation. This means time and money available at the front line of organisations. Innovation is a team sport best practiced where problems (and benefits of solutions) are felt most - at the front line.

5) Organisations need to nurture their curious minds and keep an eye on the horizon. How many organisations have 'innovation' as a core value yet have no innovation training for new staff, or a mechanism to visibly celebrate the kinds of innovations which grow and are adopted at scale?

Hmmm, what I've written sounds like a bit of a rant, so let's bring this back to Generative IA for a moment and make it more concrete.

Generative AI as a Destructive Technological Discontinuity

Generative AI will transform our society every bit as much as the Internet has done. I genuinely believe this. And its coming so much quicker than many people imagine.

Businesses who grasp this potential will see productivity improve, costs reduce and therefore market share increase. Those that do not embrace the opportunity will flounder and, unless they are in a monopoly market, they will fail.

Will the NHS adopt Gen AI and get the most from its potential? If the experience with Robotic Process Automation is anything to go by, I suspect not. (but don't get me started on that)

I've spent the last 5 years sharing perspectives on AI and automation, and whilst most people are tremendously excited and see the huge potential, there are four common negative reactions I encounter when I ramble on about Generative AI:

1. "I'm far too busy to find the time to work on how to be more efficient"
2. "Frankly I'm struggling to get the technology basics in place - don't bring me the next shiny thing to distract my teams"
3. "We could never implement this - can you imagine the HR headaches and redundancy costs associated with refining tasks and job descriptions?"
4. "I'd never consider putting Gen AI in my organisation in case it goes wrong"

These kinds objections come from sensible and expert people who I respect, with lots of experience and a real commitment to their patients and teams. They care deeply, but the system we have built in the NHS values their ability to continue to operate the status quo with diminishing resources above their ability to reimagine a new system of care enabled by technology and delivering new services through new models of care. The responses above are therefore based on a very understandable logic, but it is a logic which will not support the NHS which we desperately need in the coming years.

Conclusion

Our NHS needs to re-imagine existing care services, transcending and redefining organisational boundaries, supported by technologies that offer the potential to radically improve services. For innovation to thrive, we need to go well beyond the current prevailing model of "clinical product" innovation. Generative AI will be a major part of our future innovation and improvement toolkit. We need to take it seriously. Sooner rather than later.

If you'd like a conversation about these views on Innovation and Gen AI then please do get in touch.

Caveat: These opinions are personal and do not necessarily reflect the views of my employer or my clients.