Theme 2: Project 3 – Work Organisation, Lifelong Learning and Employee-driven Innovation in the Health Sector

What the project did

For some time, policymakers in the UK and some other countries have been promoting innovation in the healthcare sector as the solution to ‘wicked problems’. The key drivers for this include: the ageing population, increasing numbers of people with multiple long term conditions, technological advances which enabling new treatments and ways of enabling services to be delivered differently, increasing patient expectations, and the need to control costs.

Typically the source of, and resources for, innovation have been viewed as residing in specialist settings including university laboratories or dedicated innovation hubs. Whilst research and development is still regarded as a main route to innovation, there is increasing awareness of the importance of the workforce itself as a source of innovation and the need to better understand the organisational and pedagogical conditions underpinning the capacity for employee-driven innovation in the healthcare sector.

As a contribution to this debate, our research addressed the question: if, how and under what conditions can employee-driven innovation be realized in the NHS. We adopted a qualitative methodology involving key informant interviews with policy makers and professional bodies and extensive ethnographic research involving interviews and observations of day to day work and learning, completing three in-depth organisational case studies as follows:

• Moving Up: established by a Consultant to support young people with long term acute conditions to make the transition from paediatric to adult care;
• Side By Side: established a GP and Consultant to improve the experiences and outcomes of homeless people in primary and secondary care;
• City Community Health Centre:  established by GPs and community workers to provide high quality primary care to a deprived urban community. 
  

Findings

Our case study evidence has shown how some of the most innovative and sustainable solutions to the challenges faced by the health sector, lie with the expertise and daily practices of the workforce.  Our findings have illuminated the organisational conditions that facilitate and impede staff-led innovation in diverse settings located across the primary and acute care sectors, and beyond in to the third sector. Key insights are that the innovative capacity of frontline staff is grounded in their experiential and holistic expertise and understanding of patients, as well as how healthcare can be differently organised across disciplines, sectors and boundaries, to meet patient  needs.  Moreover, our evidence signals that sustainable employee-driven innovation is initiated by distinctive groups of staff, who have identified a clear weakness in services for disadvantaged or vulnerable patient groups that are often under-served by traditional models of care. Staff work closely with their ‘client groups’ to co-produce more appropriate services. Our findings have been analysed through concepts drawn from the ‘health inequalities’, ‘sociology of translation’, ‘organisation studies’ and ‘social theories of learning’ literatures. 

Whilst there are distinctive aspects to each innovation, looking across the three case studies, some overarching themes emerge:

[1] A ‘cause’: all three innovations were driven by a deep, shared and personal conviction that the organization of care was failing a vulnerable group of people and that this was unjust. From the ‘front-line’ the staff could see both how healthcare was failing these groups and what might be done about this.

[2] ‘Bricolage’: these innovations had little support from the NHS infrastructure or formal funding for staff, offices, technology, etc. Instead, the key innovators assembled ‘found’ resources that were at hand, re-purposing small pots of money, borrowing staff (and taking up offers of unpaid work), organizational spaces and even governance models.

[3] Common mechanisms, including artefacts, new forms of organisation and new work tasks and practices, were used to embed the innovation in and through everyday working and learning practices.

Impact

We have given presentations at a range of international conferences (see webpage). Two papers have been published in academic journals and two more papers are in preparation. The findings have also been discussed at events with policy makers, and also with practitioners from within and beyond the case study organisations.

1.  Cross-Case Study Workshop

In April 2016 we ran a cross-case study workshop at the Bromley-by-Bow Centre in London, which was attended by 10 key members of staff from the three case studies. The aim was to facilitate networks across the case studies and the opportunity for the staff to learn from each-other. In at least one case, staff from one site learned of new methods that they could use in their own innovation.

•  Policy & Practitioner Event

In June 2016 we ran a public event at the British Medical Association, to feedback findings and promote discussion about EDI amongst practitioners, managers, policy makers and academics.

The event attracted 60 participants, in a range of practitioner and managerial roles within healthcare (and a small number of academics <10 which on this occasion we were pleased about!). Based on the event we have written a policy briefing (https://bit.ly/2pNxjsT), which along with the research briefing has been distributed to c.300 politicians, government departments, NHS leaders, etc.

• Leadership Training: NHS London Leadership Academy

We were approached by a participant at the previous event to contribute to a training event on ‘Creativity and Innovation’ run by the NHS London Leadership Academy. In April 2016, Alison Fuller and Susan Halford ran the morning event in London, with 20 participants from across the UK representing a broad range of NHS and other organizations.

Selected publications

Fuller, A., Halford, S., Lyle, K., Taylor, R. and Teglborg, A. (2018) ‘Innovating for a Cause: the Work and Learning Required to Create a new Approach to Healthcare for Homeless people. Journal of Education and Work.

Halford, S., Fuller, F., Lyle, K and Taylor, R. (2018) Organizing Health Inequalities?  Employee-Driven Innovation and the Transformation of Care. Sociological Research Online.

Taylor, R., Fuller, A., Halford, S., Lyle, K. and Teglborg, A. (forthcoming) ‘Translating Employee – Driven Innovation in the Public Sector: the Work of Bricolage in a Context of Scarce Resources.’

Lyle, K., Fuller, A., Halford, S., Taylor, R. (forthcoming) ‘Crossing the Divide: Extending Life Chances for Young Adults with Chronic Health Conditions through learning and Innovation.’