The 7 Deadly Sins of NHS Innovation

If everyone working in the UK National Health Service had just one good new idea once in their lifetime there would be over 100 new ways to improve services each day of every year.

Ideas have one thing in common - they mostly stay as ideas. Ideas that we have in the shower rarely survive the journey into work and if they do their average life expectancy will be lunchtime! The public sector offers precious few obvious or extrinsic incentives to Innovate. Indeed, the NHS often inadvertently actually puts barriers in the way of attempts to make improvements.

In his book, The Little Black Book of Innovation: How It Works, How to Do It[i], Scott Anthony identifies the Innovation traps that squash new concepts calling them ‘Seven Deadly Sins of Innovation’. This is not the time or place for a Bible lesson but it’s worth noting that Anthony prefers the popularised list of seven (a la Brad Pitt) rather than the original:

‘There are six things that the Lord hates, seven that are an abomination to him: haughty eyes, a lying tongue, and hands that shed innocent blood, a heart that devises wicked plans, feet that make haste to run to evil, a false witness who breathes out lies, and one who sows discord among brothers.’[ii]

Anthony might also be disappointed that, using the Seven Deadly Sins to create a powerful list of things is not a new idea. A web search reveals the “Seven Deadly Sins of…: Networking, Football, Foreign Policy, Spongebob (which is particularly confusing!), Defence Spending, to name but a few with Innovation nowhere to be seen.

The first step to prevention then, is awareness.

Pride, Sloth, Lust and Greed Anthony explains, can catch out Innovators but Envy, Wrath and Gluttony are the realm of the large company. As the world’s 5th largest employer[iii] the UK NHS is a draw for these last three. We can call these NHS Super Sins.

Pride

Pride is believing, without consultation, that you know what staff, patients and service users need. End users are the main source of understanding. Get out there, ask what people want and what they need. Listen, ideate[iv] and then deliver.

Pride can also prevent adoption of innovation – “not invented here” is a common prideful that is rife in the artificial kingdoms created in the NHS. Most people don’t care about an innovation’s pedigree. If it works, they’ll adopt it.

Sloth

The NHS is often slow to adopt even proven innovation[v] Layers of bureaucracy and confused reporting often cause delay. Processes can cause death by analysis and planning and lack of personal incentive can lead to inactivity. If you have a genuinely good idea that will improve care without causing harm, ignore process. Seek forgiveness rather than permission and put your ideas into action.

Conversely, Sloth in decision-making can result in ideas being pursued long after it is clear they are of no benefit. If ideas aren’t working then you need to put your energy into ones that will.

Lust

A good innovator will define what an innovation can and cannot deliver. This avoids the risk of innovator and supporters lusting after the sexy feature-rich super solution that can never be delivered. Always scope the innovation to deliver core benefits using techniques like MoSCoW Rules (Must, Should, Could and Won’t)[vi]. The Won’t criteria being the cold shower that calms the excited innovator.

Greed

Pushing for growth too soon.

This leads to Greed. Impatience about growth leads to addressing markets where success is less likely and differentiation more difficult. Be patient about growth - ensure the innovation itself is correctly scoped, well defined and executed.

Super Sins.

Envy – NHS Super Sin 1

Innovation Teams, within Trusts, can be overly protective, and envious of success from outside their purview. Similarly, the Innovation Team can be over praised, despite the fact that the ideas themselves almost always come from the frontline - innovation is the responsibility of all employees.

Use envy to improve your own practice by approaching innovation using successful models.

Wrath – NHS Super Sin 2

“Failing faster” is seen as a good innovation strategy. This becomes difficult when “failed innovation” is punished by an angry manager. NHS obsession with governance and assurance can give rise to a backlash. Wrath should be reserved for those that fail to try.

Managers should treasure innovators.

Gluttony – NHS Super Sin 3

NHS spending increased from £37 billion in 1997 to £120 billion in 2010.

Anthony likens gluttony to over resourcing, where large budgets have innovation projects languishing in “the lab” too long. “Selective scarcity” is his solution. The NHS funding shortage can be seen as a giant innovation experiment, an “enforced scarcity.”

Conclusion

The wages of sin is the death of good ideas. Go forth, repent and be free from sin. Spread the word: It’s OK to try new things. We all want to make things better. And remember, as Thomas Edison said, “If you’re not sweating you’re not innovating”.

[i] http://www.innosight.com/little-black-book/

[ii] King James Bible Proverbs 6:16-19

[iii] http://www.bbc.co.uk/news/magazine-17429786

[iv] http://www.thefreedictionary.com/ideate

[v] http://static.bdo.uk.com/assets/documents/2012/07/NHS_Bedfordshire_-_Case_Study.pdf

[vi] http://en.wikipedia.org/wiki/MoSCoW_Method

This is a blog-size version of a piece originally published in the Health Service Journal (HSJ).