The Case to Innovate: understanding organisational innovativeness in one NHS Trust

Innovation in United Kingdom (UK) healthcare has in the last decade been driven forward through national policy and the development of a national innovation infrastructure, underpinned by an imperative to change. An increasing number of National Health Service (NHS) provider units, the NHS trusts, are making ‘innovation’ part of their strategies; however, a paucity of published theory, guidance, or information within the sector means how and why a trust should invest in and develop their innovation strategies is not well understood. In these highly complex, dynamic organisations providing 24-hour healthcare delivery, assimilation of innovation into core NHS business and realisation of the desired impact appears dangerously slow for the needs of the sector. Indeed, acceptability by individual healthcare staff within these systems of innovation as part of their role, at best appears ad hoc. This presents significant challenges for those who lead these organisations and those who work within them with specific responsibilities for innovation. This case study research explores this holistically and in-depth to gain a deep understanding of how innovation is understood and presents a theoretical model of how NHS trusts might function as innovative organisations. The case is an NHS Trust, the unit of healthcare delivery within the English National Health Service (NHS), contextualised with its organisational boundaries as a ‘mesosystem’, with individual ‘actors’ embedded within, identified as working within ‘microsystems’. In many ways the case can be seen as typical, yet as a case, also unique, both in terms of the temporal component explored and the emic perspective taken. The researcher in this study is a senior leader within the NHS Trust with a responsibility to lead the innovation strategy, she and her colleagues in other NHS trusts struggle with these issues on a daily basis. Theory from outside the United Kingdom (UK) healthcare context was used to explore the antecedents to an innovative organisation, including the need for strategy, the role of leadership, the creation of a supportive innovation environment, and the value proposition innovation might bring to this complex mesosystem. Data from multiple sources was collected over a one year period, six months after the implementation of an organisation innovation strategy within the NHS Trust. A critical realist perspective informed the data analysis and triangulation process, to give a rich description of the case, prior to using an abduction process to build on the current theory. A model that seeks to explain how a healthcare organisation might function as an innovative organisation was created that will be of direct use to the case, as it continues to develop its innovation strategy. This will be disseminated to a wider audience to support the development of NHS innovation theory and thus provide a useful resource to support other NHS trusts develop as innovative organisations.